A Medical Records Release Form (also known as a Medical Information Release Form) is a form used to request that a health care provider (physician, dentist, hospital, chiropractor, psychiatrist, etc.) release a patient's medical records, either to the patient, a third party (such as an employer, insurance company, etc.) or both.

LawDepot's Medical Records Release can also be used to request that the errors in a patient's medical records be corrected.

Why should I use LawDepot's Medical Records Release?

LawDepot's Medical Records Release Form is drafted to meet or exceed standards required by the Health Information Portability and Accountability Act, its associated regulations, notes and material published by the US Department of Health and Human Services, and State laws for the release of confidential patient information upon the patient’s (or legal representative's) written request.

Additionally, LawDepot's Medical Records Release makes requesting the release of your medical records quick and easy. The automated form allows you to request information to be sent to multiple individuals and organizations at once. So, for example, you could request three copies of your medical records - a copy for yourself, a copy for a potential employer, and a copy for your insurance company - with one form.

The form also allows you to request that your medical records be released by multiple organizations at the same time. For example, you could create one Medical Records Release form and send it to both your dentist and your physician.

Can I use the Medical Records Release to correct information in my medical file?

When you receive treatment from a health professional, such as a nurse, physician, dentist, or psychiatrist, medical records are drafted and stored in your file. Your medical records may include information about:

Your medical history

Your family's medical history

Treatments you have received

Results from laboratory tests

Results from genetic testing

Medications you have been prescribed

Results of operations and other medical procedures

Information you have provided on applications for life insurance or applications for disability

Information about your lifestyle, including:

Smoking

Recreational drug use

High-risk activities

With so much sensitive information available, it is vital that you take every step possible to protect the privacy and confidentiality of your medical records.

Will I have to pay for my medical records?

You may be charged for the costs associated with retrieving, copying, and sending medical records. The fee for this service will depend on the size of your file and the number of copies you are requesting. In most cases, the amount charged must be "reasonable", but different health care providers may charge different amounts for copying the same information.

If you absolutely cannot afford to pay for your medical records, you can try submitting a note to your health care provider stating that you cannot afford to pay for the charges. In these cases, the health care provider might provide you with copies of your medical records free of charge.

The Patient

Who is the Patient?

The patient is the individual who is seeking to have Medical Records released.

What is a Minor?

A minor is a person who is under the age of majority in their residing state. For example, in the state of Montana, the age of majority is 18, so all individuals under the age of 18 are considered minors. If the patient is a minor, a parent or guardian will have to request the release of the patient's medical records.

What is a Dependent Adult?

A dependent adult is an adult who is dependent on one or more people for support or care. A dependent adult could be under another's care by way of a medical directive, court order, power of attorney, etc.

Corrections to Existing Medical Records

Why is it important to correct errors contained in my medical records?

Errors in your medical records can lead to serious problems, including but not limited to the following:

Errors in diagnosis

If current or past symptoms and/or treatments are recorded incorrectly, the incorrect information can cause errors in future diagnoses.

Errors in treatment

Errors in treatment, caused by errors in a patient's medical records, are not uncommon. For example, a patient's medical records could fail to state that the patient is allergic to a common treatment, or the records might incorrectly list a medication that the patient takes, which could lead to two conflicting medications being administered at the same time.

Also, if errors in your medical records caused an incorrect diagnosis, that incorrect diagnosis can lead to errors in treatment.

Problems with insurance

Applying for Insurance: Errors in your medical records can adversely affect you when you apply for health insurance or life insurance. An error can cause an insurance company to believe that you are sicker than you actually are. This can lead to increased premiums or, in extreme cases, refusal of coverage. As such, it is always a good idea to review your medical records for errors before you apply for insurance.

Although the best practice is to review all of the information in your medical records for errors, you should pay special attention to the following:

Doctor's Notes

Records from testing centers, hospitals, clinics, and other facilities that the patient has visited.

Insurance billing and codes

Results from medical tests

How should I list corrections that are required?

When listing corrections that are required, you should do so in complete sentences, using as much detail as necessary to identify the corrections that need to be made. You should list pages, dates, doctors' names, and any other information that can be used to correctly identify the error(s) that should be corrected. If more than one correction is required, you may wish to letter the corrections, as illustrated in the following example.

a. On page 6 of Dr. Smith’s Chart Notes, which are dated November 22, 2002, the prescription noted is incorrectly labeled as "Tylnol 3" instead of "Tylenol 3".

b. Under the patient contact information listed on page 1 of Dr. Smith's Chart Notes, which are dated June 4 2004, the patient's phone number is incorrectly listed as "555-1234". The patient's phone number is actually "555-1324".